Abstract：
In 2018, Borna Disease Virus 1 (BoDV-1) was confirmed as a human zoonotic pathogen causing rare but fatal encephalitis in Germany. While diagnostic procedures and the clinical picture have been described, epidemiology remains mysterious. Though endemic areas and a natural reservoir host have been identified with the shrew Crocidura leucodon shedding virus in secretions, transmission events, routes and risk factors are unclear. We performed the first comprehensive epidemiological study, combining a large case series with the first case-control study: We interviewed family members of 20 PCR-confirmed BoDV-1 encephalitis cases deceased in 1996-2021 with a standardized questionnaire covering medical history, housing environment, profession, animal contacts, outdoor activities, travel, and nutrition. Cases\' median age was 51 (range 11-79) years, 12/20 were female, and 18/20 lived in the federal state of Bavaria in Southeastern Germany. None had a known relevant pre-existing medical condition. None of the interviews yielded a transmission event such as direct shrew contact, but peridomestic shrew presence was confirmed in 13 cases supporting environmental transmission. Residency in rural areas endemic for animal BoDV-1 was the common denominator of all cases. A subsequent individually matched case-control study revealed residence close to nature in a stand-alone location or on the fringe of the settlement as a risk factor for disease in multivariable analysis with an adjusted OR of 10.8 (95% CI 1.3-89.0). Other variables including keeping cats were not associated with disease. Targeted prevention, future post-exposure-prophylaxis, and timely diagnosis remain challenging.
摘要：
2018年，博尔纳病病毒1（BoDV-1）被确认为人类人畜共患病原体，在德国引起罕见但致命的脑炎。虽然已经描述了诊断程序和临床表现，流行病学仍然神秘。尽管已经确定了流行地区和天然的水库宿主，但分泌物中存在着Crociduraleucodon脱落病毒，传输事件，路线和危险因素尚不清楚。我们进行了第一次全面的流行病学研究，将大型病例系列与第一个病例对照研究相结合：我们采访了1996-2021年死亡的20例PCR证实的BoDV-1脑炎病例的家庭成员，并使用涵盖病史的标准化问卷，住房环境，职业,动物接触,户外活动,旅行,和营养。病例的平均年龄为51岁（范围11-79岁），12/20是女性，18/20居住在德国东南部的巴伐利亚联邦州。没有人具有已知的相关预先存在的医疗状况。没有一次采访产生了传播事件，比如直接接触泼妇，但在13例支持环境传播的病例中证实了peridomestive的存在。在农村地区，BoDV-1特有的居民是所有病例的共同点。随后的一项单独匹配的病例对照研究显示，在多变量分析中，在独立位置或定居点边缘处接近自然的住所是疾病的危险因素，调整后的OR为10.8（95％CI1.3-89.0）。包括饲养猫在内的其他变量与疾病无关。有针对性的预防,未来的暴露后预防和及时诊断仍然具有挑战性.
